44: Antibiotic Administration for Meconium Aspiration Syndrome in Neonates: A Systematic Review

Abstract

Meconium aspiration syndrome (MAS) is a common cause of respiratory distress in neonatal period. Antibiotic treatment is one of medical therapy which widely used in newborns with MAS but the efficacy of routine antibiotic administration is doubtful. To conduct a systematic review of the clinical trials evaluating the role of antibiotics in MAS. We searched Medline, EMBASE, CENTRAL AND CINAHL, SCOPUS, International Pharmaceutical Abstracts, Proquest Dissertations and Theses and EBM Reviews (until August 2013). Studies were included if they satisfied the following criteria: randomized or quasi-randomized trials comparing the use of antibiotics to no antibiotics for treatment or prevention of MAS and reporting on any of the following outcomes: development of infection, need for ventilation or oxygen support, duration of hospital stay, air leaks syndrome, PPHN, need for ECMO or inhaled nitric oxide (iNO), and mortality. We calculated relative risks (RR) for the dichotomous outcomes and mean differences (MD) for the continuous outcomes, along with the 95% CIs. Four RCTs were identified; three studies enrolled subjects for treatment of MAS and one study evaluated prophylactic use of antibiotics in infants exposed to meconium stained amniotic fluid (MSAF). These trials enrolled 693 infants in total and the duration of antibiotics used was three to seven days. All studies excluded subjects considered to be at higher risk for neonatal sepsis at onset due to antenatal risk factors and/or positive septic screen. There were no difference in development of infection (RR 0.67 [95% CI 0.28 to 1.59] for clinical sepsis and 0.93 [95% CI 0.36 to 2.40] for culture-proven sepsis), mortality (RR 1.25 [95% CI 0.36 to 4.39]), need for ventilation (RR 1.16 [95% CI 0.50 to 2.66] for mechanical ventilation and 1.09 [95% CI 0.71 to 1.69] for CPAP), duration of oxygen (MD −0.64 [95% CI −1.49 to 0.21]), air leaks syndrome (RR 1.56 [95% CI 0.62 to 3.91]) and hospital stay (MD 0.16 days [95% CI −1.16 to 1.48]) between the two groups. In neonates who are otherwise at low-risk for neonatal sepsis, there is insufficient evidence to support the routine use of antibiotics for treatment of MAS or for prophylaxis in infants exposed to MSAF.